Thursday, June 22, 2017

In the Fight: What U.S. Army Mental Health Tells Us about Goal Conflict

Goal conflict is a necessary and central part of how
organizations work. This is true even if we ignore personal goals that may
differ from the organization’s and focus only on the goals that all have to meet,
at the same time, for the organization to function well. Cars are made in
production lines that require quality, speed, and low cost. Airlines require safety,
service, and low cost. Health care requires personal attention, standardized
procedures, treatment of all possible conditions, and again low cost. And
finally, important for this blog, an army requires its soldiers to inflict
injury on others, risk or experience injury themselves, and maintain mental
health good enough to go out and do it all over again.

A paper in Administrative Science Quarterly by Julia DiBenigno looked at the goal conflict between the U.S. Army’s commitments to
providing mental health care and keeping its force mission-ready, and her
findings are important for any organization. She addressed a fundamental
problem of goals that are in conflict: usually each goal is assigned to
specialists with expertise in that specific goal, so resolution does not happen
inside someone’s head but rather as an interaction between the people in charge
of each specific goal. Usually that is done by prioritizing one goal and
assigning the other goal to a service-providing or supervisory function in the
organization.

The U.S. Army exists for fighting, and naturally commanders
are in charge. But mental health care is also a high-priority goal because the
recent wars have put a heavy load on each soldier, and post-traumatic stress
disorder and affiliated conditions take highly trained soldiers out of action.
Many even commit suicide, spreading the pain more broadly to also affect families
of military personnel. This is recognized as a key problem by everyone
involved, but solving it involves negotiation between specialists. This leads
to push-and-pull with two frequent results: the health care provider is coopted
by the commander and serves the commander’s purpose, or the health care
provider stays anchored in the care identity and interferes with the
commander’s purpose. As a result, most conflicts are poorly solved: analysis
found that 5 percent ended with a good mutual solution, in 85 percent either
the commander or the health care provider won the battle, and in 10 percent
both lost out.

But here is the key message of the article. The statistics I
cited were for only two of the four brigades DiBenigno studied. In the other
two, 89 percent of conflicts led to a good mutual solution, in 7 percent one
party won but not the other, and in 4 percent both lost. This is a really large
difference, and the reason for it boiled down to one minor change in
organizational structure with major consequences for the process. In the
successful brigades, each health care provider was embedded in the clinic but
also assigned as a point of contact with specific commanders, which led to
longer and more personal interactions than in the other two brigades. The
result was an anchored personalization: the provider was anchored in a group of
other mental health professionals who shared knowledge and norms, and the
provider had a personal network of commanders that allowed learning each
commander’s needs and earning trust as well.

The personal interaction proved to be central to
understanding each other’s thinking and finding adaptive actions in each
situation. It had a massive effect on the ability to find good solutions,
especially because the goal conflict was unique in each case. Mental health
issues are complex, but so are the needs of military units and their
commanders. Perhaps most remarkable is the origin of the difference in problem-solving
capacity: just a simple change in organizational structure that regulated which
care providers interacted with which commanders created a total change in how
these interactions were done. It’s an important lesson for organizational
design – how it is done determines what happens later.